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. 2022 Nov;9(2):e002154.
doi: 10.1136/openhrt-2022-002154.

Risk of atrial fibrillation and stroke among older men exposed to prolonged endurance sport practice: a 10-year follow-up. The Birkebeiner Ageing Study and the Tromsø Study

Kristoffer Robin Johansen  1   2 , Anette Hylen Ranhoff  3   4 , Eivind Sørensen  4   5 , Bjarne M Nes  6 , Kim Arne Heitmann  7 , Turid Apelland  5 , Silvana Bucher Sandbakk  8 , Tom Wilsgaard  9 , Maja-Lisa Løchen  9   10 , Dag S Thelle  11   12 , Bente Morseth  7   2 , Marius Myrstad  5   13 ; NEXAF initiative
Collaborators, Affiliations

Risk of atrial fibrillation and stroke among older men exposed to prolonged endurance sport practice: a 10-year follow-up. The Birkebeiner Ageing Study and the Tromsø Study

Kristoffer Robin Johansen et al. Open Heart. 2022 Nov.

Abstract

Aims: Endurance sport practice is associated with a high prevalence of atrial fibrillation (AF), which increases the risk of stroke in the general population. However, stroke risk in endurance athletes with AF is sparsely investigated. Most studies have been limited by design and are largely restricted to younger and middle-aged populations. Thus, we aimed to investigate AF and stroke risk in older athletes exposed to prolonged endurance training.

Method: During a 10-year period, 505 male athletes aged ≥65 years frequently participating in a long-distance ski race were compared with 1867 men of the same age from the general population. The main exposure was endurance sport practice with self-reported AF and stroke as outcomes. Stroke risk was further examined by joint modelling of AF and endurance practice. Statistical analysis was conducted with a modified Poisson model.

Results: Athletes (median age: 68, range: 65-90) participated in a long-distance ski race over a median of 14 years (range: 1-53). Prevalence (28.5% vs 17.8%) and adjusted risk of AF (risk ratio (RR): 1.88, 95% CI: 1.49 to 2.37) were higher in athletes compared with non-athletes, whereas the prevalence (5.4% vs 9.7%) and risk of stroke were lower (RR: 0.60, 95% CI: 0.37 to 0.95). Compared with athletes without AF, risk of stroke was twofold in athletes (RR: 2.38, 95% CI: 1.08 to 5.24) and nearly fourfold in non-athletes (RR: 3.87, 95% CI: 1.98 to 7.57) with AF.

Conclusion: Although older male endurance athletes experienced an increased risk of AF, the long-term risk of stroke was substantially reduced compared with non-athletes.

Keywords: atrial fibrillation; epidemiology; stroke.

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Conflict of interest statement

Competing interests: M-LL has received lecture fees from Bayer, Sanofi and BMS/Pfizer not related to this study. MM has received lecture fees from Bayer, Boehringer-Ingelheim, Bristol Myers Squibb, mSD and Pfizer not related to this work.

Figures

Figure 1
Figure 1
Flow chart of participants included in the study. The Birkebeiner Ageing Study and the Tromsø Study. AF, atrial fibrillation.
Figure 2
Figure 2
Risk ratio with 95% CIs for self-reported atrial fibrillation by joint associations of self-reported leisure-time physical activity and endurance sport practice. Non-athletes: participants from Tromsø6; athletes: participants from the Birkebeiner Ageing Study. (A) Adjusted for age, body height, education, smoking status and frequency of alcohol intake. (B) Additionally adjusted for coronary heart disease, diabetes, body mass index and antihypertensive medication. Y-axis values are given on a logarithmic scale.
Figure 3
Figure 3
Risk ratio with 95% CI for self-reported stroke by joint associations of athlete status and participants reporting atrial fibrillation (AF) status during the study. Non-athletes: participants from Tromsø6; athletes: participants from the Birkebeiner Ageing Study. (A) Adjusted for age, body height, education, smoking status and frequency of alcohol intake. (B) Additionally adjusted for body mass index and antihypertensive medication. Participants reporting coronary heart disease and diabetes at baseline have been excluded. Y-axis is given on a logarithmic scale.
See this image and copyright information in PMC

References

    1. Chugh SS, Roth GA, Gillum RF, et al. . Global burden of atrial fibrillation in developed and developing nations. Glob Heart 2014;9:113–9. 10.1016/j.gheart.2014.01.004 - DOI - PubMed
    1. Meschia JF, Bushnell C, Boden-Albala B, et al. . Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American heart Association/American stroke association. Stroke 2014;45:3754–832. 10.1161/STR.0000000000000046 - DOI - PMC - PubMed
    1. Sattelmair J, Pertman J, Ding EL, et al. . Dose response between physical activity and risk of coronary heart disease: a meta-analysis. Circulation 2011;124:789–95. 10.1161/CIRCULATIONAHA.110.010710 - DOI - PMC - PubMed
    1. Pandey A, Garg S, Khunger M, et al. . Dose-response relationship between physical activity and risk of heart failure: a meta-analysis. Circulation 2015;132:1786–94. 10.1161/CIRCULATIONAHA.115.015853 - DOI - PubMed
    1. Morseth B, Graff-Iversen S, Jacobsen BK, et al. . Physical activity, resting heart rate, and atrial fibrillation: the Tromsø study. Eur Heart J 2016;37:2307–13. 10.1093/eurheartj/ehw059 - DOI - PMC - PubMed

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